Bladder control problems in women: Lifestyle strategies for relief

Bladder control problems in women: Lifestyle strategies for relief

You've been struggling with the embarrassment and discomfort of a bladder control problem for some time now. Maybe you hoped it would go away on its own, but things aren't getting any better. In fact, your bladder control problem is gradually getting worse.

You're ready to make some changes, but what exactly can you do? There are some simple strategies you can try on your own that may help improve your bladder control problem.

Doctors often call these strategies "behavior therapies." They're safe, easy, effective and inexpensive. These techniques can be used before resorting to other types of treatment, such as medications or surgery, or in combination with them. Sometimes behavior therapies are the only treatment you need. In some cases, they're as effective as — or even more effective than — medication.

Focus on fluids and food

How much fluid you drink and the types of food you eat may influence your bladder habits.

Too much fluid
Drinking too much fluid of any kind makes you urinate more often. If you drink too much over a short time, this can overwhelm your bladder and create a strong sense of urgency. If you exercise a lot or work outdoors regularly, you may need to drink additional fluids. But rather than drink a large amount all at once, try drinking smaller amounts throughout the day. For example, drink about two 8-ounce glasses (237 milliliters) at each meal and one 8-ounce glass between meals. That way, you'll end up at the recommended amount of roughly 60 to 64 ounces (about 1,775 to 1,900 milliliters) of fluid daily.

If you have to get up several times at night to urinate, try drinking more of your fluids in the morning and afternoon, and eliminate alcohol and caffeinated beverages. Although water is best for your bladder, remember that fluids come from any beverage you drink and from foods such as soup.

Too little fluid
Drinking too little fluid can lead to increased concentrations of body waste products in your urine. Highly concentrated urine is dark yellow and has a strong smell. It can irritate your bladder, increasing the urge and frequency with which you need to go.

Bladder irritants
Some foods and beverages can irritate your bladder as well. Caffeine and alcohol both act as diuretics, which means that they increase urine production. This can lead to increased frequency and urgency of urination. Caffeine can also cause bladder spasms.

If caffeine or alcohol is a regular part of your diet, try eliminating it for about a week to see if your symptoms improve. Consider also avoiding foods that might be bladder irritants for about a week or so. Then gradually — every one to two days — add one food back into your diet, making note of any changes in urinary urgency, frequency or incontinence.

You might not even have to eliminate your favorite foods entirely. Simply cutting down on the amount might help, too.

Try bladder training

When you have an overactive bladder, you can become accustomed to urinating frequently or at the slightest urge. Sometimes, you may go to the toilet even when you don't have the urge because you want to avoid an accident. After a while, your bladder begins sending "full" messages to your brain even when it's not full, and you feel compelled to urinate.

Bladder training, or retraining, involves adjusting your habits. You go to the toilet on a set schedule — even if you have no urge to urinate — gradually increasing the time between urination. This allows your bladder to fill more fully and gives you more control over the urge to urinate.

A bladder-training program usually follows these basic steps:

Find out your pattern. For a few days, keep a diary in which you note every time you urinate. Your doctor can use this diary to help you establish a schedule for your bladder training.

Extend your urination intervals. Using your bladder diary, pinpoint the amount of time from one urination to the next. Then extend that interval by 15 minutes. So, if your usual interval is one hour, you work to extend that interval to an hour and 15 minutes.

Stick to your schedule. Once you've established a schedule, do your best to stick to it. Start by urinating immediately after you wake up in the morning. Thereafter, if an urge arises, but it's not time for you to go, try as hard as you can to wait it out. If you feel you're going to have an accident, go to the toilet but then return to your present schedule. Strengthening the pelvic floor muscles by rhythmically contracting and relaxing those muscles (Kegel exercises) can significantly improve your ability to extend the time between urination.

Practice relaxing. If you feel a sudden need to urinate before your scheduled time, try to stand still or sit down. Then work on relaxing by taking deep breaths, imagining the urge going away and contracting your pelvic muscles. Once you feel relaxed, slowly make your way to the bathroom if you still need to. With time, this practice can help reduce feelings of urgency.

Increase your intervals. Gradually lengthen the time between trips to the toilet until you reach intervals of two to four hours. You might do this by extending your intervals an additional 15 minutes each week until you reach the desired goal. Be sure to increase your time limit slowly so that you give yourself the best chance for success.

Don't be discouraged if you don't succeed the first few times. Keep practicing, and your ability to maintain control is very likely to increase.

Strengthen your pelvic floor

Your pelvic floor muscles and urinary sphincter help control urination. You can strengthen these muscles by regularly doing pelvic floor exercises, commonly referred to as Kegels. The pelvic floor muscles work to open and close the urethra — the tube that carries urine from the bladder to the exterior of your body. These muscles also support the bladder as you exert yourself doing everyday activities such as walking, standing, lifting and sneezing.

Practice Kegel exercises. To perform Kegels, squeeze your pelvic floor muscles as if you're trying to stop your stream of urine. Your doctor may recommend that you do a set of these exercises three or four times a day to treat your bladder control problem. Kegels are especially effective for women with stress incontinence, but they can also help reduce or eliminate urge incontinence. You may want to ask your doctor for help or to refer you to a specialist who can teach you the proper way to do these exercises, because many people unknowingly practice incorrectly. When you're first learning Kegels, it's most effective to practice them while lying down in a quiet place. This way you can concentrate better.

Biofeedback. Biofeedback is a behavior therapy that's used to help train pelvic floor muscles. Sensors are placed near the muscles that are being monitored. The sensors transmit exertion levels to a computer, which displays the levels on the screen. This immediate feedback helps some people master Kegel exercises faster because they can see whether they're using the correct muscles. Biofeedback can be done with a health care provider or with a home device. The idea is that once you've had enough feedback, you can confidently do the exercises on your own without the equipment.

Vaginal weights. Cone-shaped weights are another option used to help with Kegel exercises. You place a weight in your vagina and contract your pelvic floor muscles to keep it from falling out. Many cones come in sets of varying weight levels, so you can build up to heavier weights as your pelvic floor muscles become stronger.

Pelvic floor muscles

Your pelvic floor muscles comprise several layers of muscle attached to the front, back and sides of your pelvic bone. These muscles help control urination.
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Control contributing factors

Certain medications, excess weight, smoking and physical inactivity may indirectly contribute to bladder control problems. If you address these factors, bladder-specific techniques — such as avoiding bladder irritants and bladder training — may be even more likely to work.

Manage your medications. Examples of drugs that may contribute to bladder control problems include high blood pressure drugs, heart medications, diuretics, muscle relaxants, antihistamines, sedatives and antidepressants. If you develop problems with incontinence or difficulty urinating while taking these drugs, talk to your doctor. You may be able to avoid urinary side effects by taking another medicine.

Maintain a healthy weight. Being overweight may contribute to bladder control problems, particularly stress incontinence. Excessive body weight puts pressure on your abdomen and bladder, sometimes resulting in leakage. If you're overweight and experiencing a bladder control problem, losing weight may be one way to help.

Stop smoking. Smokers are more likely to have bladder control problems and are more likely to experience more-severe symptoms. Heavy smokers also tend to develop a chronic cough, which can place added pressure on the bladder and aggravate urinary incontinence. Improving urinary incontinence may be one of many benefits of stopping smoking.

Start exercising. Some studies indicate that regular physical activity reduces bladder control problems. Try for at least 30 minutes of moderate activity — such as walking briskly, biking or swimming — most days of the week.

Minimize constipation. Straining excessively during bowel movements can damage the pelvic floor. And unfortunately, some medications used to treat bladder control problems can make constipation worse. Exercising, drinking enough water and eating high-fiber foods, such as lentils, beans, and fresh vegetables and fruit, may help improve constipation.

Manage chronic cough. If you have a cough that doesn't go away, it could make your bladder control problem worse. Smoking is a common cause of chronic cough. If you don't smoke, the cough could be caused be a treatable condition, such as allergies or a sinus infection.

Your role in treatment

Behavior therapies can improve bladder control with minimal side effects. These techniques take some time and practice before you begin seeing results. But persistence pays off. If you stick with the program, you'll more than likely see an improvement in your symptoms. And if one of these approaches doesn't work, talk with your doctor about exploring other treatment options that may help.